AMA/KPMG Survey: Docs Still Frustrated by MACRA’s Complexities

June 28, 2017
A new survey of 1,000 practicing physicians who have been involved in practice decision-making related to MACRA’s Quality Payment Program (QPP) shows that fewer than one in four physicians who have begun to get ready for the program feel well prepared to meet its requirements in 2017.

A new survey of 1,000 practicing physicians who have been involved in practice decision-making related to MACRA’s Quality Payment Program (QPP) shows that fewer than one in four physicians who have begun to get ready for the program feel well prepared to meet its requirements in 2017.

The survey, conducted by the American Medical Association (AMA) and KPMG LLP, the U.S. audit, tax and advisory firm, also revealed that more than half of the leading physicians believe that MACRA’s (the Medicare Access and CHIP Reauthorization Act’s) requirements are “very” burdensome.

However, seven in ten respondents did say that they have begun preparing to meet the requirements of the QPP in 2017. Of those respondents, though, 65 percent said they feel “somewhat prepared” and 23 percent said they feel “well prepared” to meet requirements in 2017.

MACRA encourages physicians to adopt value-based payment models in healthcare that connect Medicare’s reimbursement to quality and performance reporting. The law went into effect this year with “pick your pace” options for those required to participate in the QPP. Of those physicians responding to the survey, 56 percent plan to participate in the Merit-based Incentive Payment System (MIPS) in 2017, a payment system with variable incentive payments or penalties based on certain quality and efficiency measures, while 18 percent are expecting to qualify for higher and more stable payment as an Advanced Alternative Payment Model (APM) participant. Another 7 percent expect to participate in an APM, but not meet the qualifying participant standard; 8 percent do not expect to participate; and 12 percent do not know whether and how they will participate in 2017.

Just last week, the government released a proposed rule for MACRA’s QPP in 2018, with a core aim to help simplify things for small, independent and rural practices. To this end, this survey found that while these small practice physicians do need more help than larger organizations, some challenges are universal regardless of practice size, specialty, or previous value-based care experience, particularly the time required and the complexity of reporting.

While the rule that was released last week didn’t contain the same “pick your pace” affordability that eligible clinicians were granted in 2017, the proposal does offer some flexibilities of its own for 2018. As such, survey respondents who feel that MACRA is already too burdensome this year likely will be frustrated in 2018 as well.

“This survey showed that about a third of respondents are unlikely to meet the basic standard of one patient, one measure, no penalty,” AMA President David O. Barbe, M.D, said in a statement.

For this survey, the largest cohort of respondents (25 percent) are in a physician practice with between 5 and 10 clinicians; 20 percent of respondents were in a practice size of 2 to 4 physicians; 15 percent had a practice just on their own; and 22 percent were in practice sizes of 25 or more physicians.

The AMA/KPMG survey was released at the Eighth Annual Alternative Payment Model (APM) and Accountable Care Organization (ACO) Summit this week, and found that a majority (51 percent) of surveyed physicians who are involved in practice decision-making are somewhat knowledgeable about MACRA and the QPP, and only 8 percent describe themselves as “deeply knowledgeable” about the program and its requirements.

In addition, 90 percent felt the reporting requirements were “somewhat” or “very” burdensome, with the time required to report performance being the most significant challenge, followed by understanding requirements, how MIPS performance is scored, and the cost required to accurately capture and report performance

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